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Adequacy of prenatal care utilization, maternal ethnicity, and infant birthweight in Chicago
J W Collins1, S N Wall, R J David
1Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA.
Insights
Racial disparities in infant birthweight persist despite adequate prenatal care. Maternal race, or related factors, significantly impacts pregnancy outcomes, independent of care utilization. Keywords: infant birthweight, prenatal care, racial disparity.
Area of Science:
- Public Health
- Perinatal Epidemiology
- Sociomedical Sciences
Background:
- Racial disparities in infant birthweight are a significant public health concern.
- The role of prenatal care utilization in explaining these disparities requires further investigation.
Purpose of the Study:
- To determine if the Adequacy of Prenatal Care Utilization Index explains racial disparities in infant birthweight.
- To analyze the relationship between prenatal care, race, and infant birthweight in a specific urban cohort.
Main Methods:
- Stratified analysis of singleton births in Chicago (1982-1983).
- Inclusion of African-American, Mexican-American, and non-Latino white infants.
- Controlled for potential confounders by selecting an older cohort.
Main Results:
- Adequacy of prenatal care varied by race and residence.
- The African-American birthweight disadvantage persisted even with adequate or adequate-plus prenatal care in moderate-income areas.
- Race-specific low birthweight rates improved with increased prenatal care, but relative racial positions remained unchanged.
Conclusions:
- Maternal race, or closely associated factors, influences pregnancy outcomes independently of prenatal care adequacy.
- Prenatal care utilization alone does not fully account for racial disparities in infant birthweight.
Abstract:
This study examines the extent to which the Adequacy of Prenatal Care Utilization Index explains the racial disparity in infant birthweight. A stratified analysis was performed on all African-American, Mexican-American, and non-Latino white singleton infants born in Chicago, Illinois between 1982 and 1983. This older cohort was chosen to avoid the confounding effect of cocaine associated with its increased local availability after 1985. The adequacy of prenatal care utilization varied by race and place of residence. However, in moderate-income areas (median family annual income of $20,001 to $30,000), the African-American birthweight disadvantage persisted among infants born to mothers who received adequate and adequate-plus prenatal care. Similarly, although race-specific term (gestational age > 37 weeks) low birthweight rates declined as prenatal care usage rose, the position of African Americans relative to Mexican Americans and whites was essentially unchanged. These findings indicate that maternal race or some factor closely related to it affects pregnancy outcome regardless of the adequacy of prenatal care utilization.